Association of Aspirin Resistance with Increased Mortality in Ischemic Stroke

OBJECTIVE: To investigate the association of aspirin resistance (AR) with mortality in a cohort of Chinese patients with acute ischemic stroke (AIS). METHODS: One hundred and ninety-six ischemic stroke patients who received at least 7 days of aspirin therapy prior to stroke onset were enrolled. The outcome measure was all-cause and cardiovascular disease (CVD) mortality at 1-year follow-up. The relation of AR with the two end points was investigated with the use of logistic regression models. RESULTS: The median age of included patients was 65(IQR, 56-76) years and 82(41.8%) were female. Thirty-five patients were defined as AR; thus, the rate was 17.9% (95%CI, 12.5% to 23.2%). The median NIHSS score was significantly higher in patients with AR than those with AS [12 (IQR, 10-17) vs. 7 (IQR, 4-10); Z=5.188; P<0.001]. Similarly, the median infarct volume was also significantly higher in AR than in AS [18.8 (IQR, 4.3-25.2) ml vs. 13.2 (IQR, 3.3-18.7) ml; Z=3.322; P=0.008]. During follow-up there were 43 patients (21.9%) died, including 24 CVD mortality (12.2%). In univariate logistic regression analysis, we found that the rate of all-cause mortality and CVD mortality increased by 390% (OR=4.90; 95%CI:2.24-10.75) and 422% (OR=5.22; 95%CI, 2.10-12.98) in AR group. After adjusting for all other significant predictors, AR still associated with high mortality and the rate of all-cause mortality and CVD mortality increased by 215% (OR=3.15; 95%CI:1.88-4.93) and 231% (OR=3.31; 95%CI, 1.96-522), respectively. CONCLUSIONS: The present study shows that AR was a useful prognostic marker of all-cause or CVD mortality in Chinese patients with AIS.